../ IS  
┌tgefi­ gŠ­askjal: Lei­beiningar
Skjaln˙mer: Rsřk-370
┌tg.dags.: 11/16/2018
┌tgßfa: 8.0
3.03.04.06 NŠmisprˇf ß gersveppum
Hide details for TilgangurTilgangur
Skilgreina hvenŠr nŠmisprˇf ß gersveppum eru framkvŠmd og hva­a lyf eru notu­. Lei­beiningarnar gilda um nŠmisprˇf ß Candida gersveppum, hvort sem ■eir greinast ß bakterÝudeildum e­a sveppadeild SřklafrŠ­ideildar. Fyrir gersveppi a­ra en Candida, sjß heimildir Arendrup et al, 2014, Espinel-Ingroff et al, 2012 og Perfect et al. 2010 Ý heimildalista.
Hide details for ┴bendingar og bakgrunnur┴bendingar og bakgrunnur
┴bendingar
NŠmisprˇf eru ger­ Ý ÷llum dj˙pum sřkingum og geta veri­ hjßlpleg Ý ÷­rum sřkingum, sjß t÷flu.
Bakgrunnur
LyfjanŠmi Candidaer breytilegt eftir tegundum, og einnig getur nŠmi veri­ mismunandi innan s÷mu tegundar. Ůegar gersveppir rŠktast frß lÝffŠrum sem ekki eru ÷rverufrÝ, s.s. slÝmh˙­um og h˙­, ■arf sjaldnast a­ me­h÷ndla sj˙kling, ■vÝ ■eir eru hluti af e­lilegri lÝkamsflˇru. Dj˙par sřkingar Ý blˇ­i og innri lÝffŠrum ■arf ■ˇ alltaf a­ me­h÷ndla, og raunverulegar sveppasřkingar Ý ÷­rum lÝffŠrum eru lÝka venjulega me­h÷ndla­ar. Lyf sem prˇfu­ eru reglulega eru amphotericin B (AP), fluconazole (FL), voriconazole (VO) og anidulafungin (AND) e­a micafungin (MYC). Flucytosine (FC) og ketoconazole (KE) eru lÝti­ sem ekkert notu­ Ý me­fer­ hÚr ß landi og ■vÝ eru ■au einungis prˇfu­ samkvŠmt sÚrstakri bei­ni lŠknis e­a sřklafrŠ­ings.
Hide details for A­fer­ og val lyfjaA­fer­ og val lyfja
A­fer­
Notu­ eru Etest frß bioMÚrieux og prˇfin framkvŠmd skv. lei­beiningum. T˙lkun ß ni­urst÷­um er ger­ Ý samrŠmi vi­ Eucast sta­al, sjß nŠmisprˇf - sveppir - val og vi­mi­unarm÷rk. Tafla 1 er lei­beinandi fyrir framkvŠmd nŠmisprˇfa og val lyfja Ý r˙tÝnuvinnu. ═ sÚrst÷kum tilfellum geta lŠknar ßkve­i­ anna­ en taflan tilgreinir. Vi­ val ß lyfjum var teki­ tillit til marka­sleyfis fyrir vi­komandi sřkingar (■.e. lyf hefur leyfi fyrir ßkve­nar sřkingar).

Tafla. NŠmisprˇf ß gersveppum og lyf sem notu­ eru hverju sinni (lyfjaval byggir ß heimildum Ý heimildalista)
Tegund sřnisNŠmisprˇfSveppalyf
Blˇ­AlltafAP, FL, VO, AND/MYCa
Ă­aleggurAlltafAP, FL, VO, AND/MYCa
Innri lÝffŠri – ÷rverufrÝ, ■.ß.m. kvi­arhol, brjˇstholAlltafAP, FL, VO, AND/MYCa
ÍndunarfŠrasřniEkki Ý r˙tÝnu. Skv. bei­ni lŠknisAP, FL, AND/MYCa
ŮvagEkki Ý r˙tÝnu. Skv. bei­ni lŠknisAP, FL, AND/MYCa,b
Munnhol og vÚlinda
  • Ekki Ý r˙tÝnu nema ef HIV sřktir me­ endurteknar sřkingar e­a endurteknar fluconazole me­fer­ir (■.e. ef fram kemur ß bei­ni)
  • Skv. bei­ni lŠknis
  • AP, FL, IT
  • Munnhol: mß bŠta vi­ PC og AND/MYCa ef FL og IT ˇnŠmi e­a ekki klÝnÝsk sv÷run
  • VÚlinda: bŠta vi­ AND/MYCa og VO
  • ŮarmarNei
    Skei­ og sk÷p, ytri kynfŠri karlaEkki Ý r˙tÝnu. Skv. bei­ni lŠknisAP, FL, IT
    H˙­
  • Alltaf ef vefjasřni
  • Annars ekki Ý r˙tÝnu. Skv. Bei­ni lŠknis
  • AP, FL, IT
    Eyru og augu
  • Alltaf ef sřni ˙r mi­eyra e­a augnk˙lunni (endophthalmitis)
  • Annars skv. bei­ni lŠknis
  • AP, FL, IT
  • Endophthalmitis: bŠta vi­ VOc
  • Skammstafanir og ne­anmßlsathugasemdir:
    AND: anidulafungin; MYC: micafungin; AP: amphotericin B; FL: fluconazole; IT: itraconazole; PC: posaconazole; VO: voriconazole.
    aAND/MYC: prˇfa micafungin ef C. albicans, C. glabrata e­a C. parapsilosis. Ef ÷nnur Candida tegund ■ß skal prˇfa bŠ­i micafungin og anidulafungin;
    bEchinocandin skiljast ekki vel ˙t Ý ■vagi en ■ˇ hefur veri­ lřst ßrangri Ý me­fer­ ■vagfŠrasřkinga me­ micafungin og caspofungin gŠti m÷gulega gagnast vi­ pyelonephritis.
    cVoriconazole er ekki marka­sett fyrir augnsřkingar, en ■Šr ver­a oft ˙t frß blˇ­sřkingu (marka­ssett fyrir blˇ­sřkingar) og a­ auki kemst lyfi­ innÝ innra hˇlf augans.
    Hide details for HeimildirHeimildir
    1. Jorgensen JH, Pfaller MA og fÚl. Manual of Clinical Microbiology.
    2. Amy L. Leber og fÚl. Clinical Microbiology Procedures Handbook.
    3. Arendrup MC et al. ESCMIDand ECMMjoint clinical guidelines for the diagnosis and management of rare invasive yeast infections. Clin Microbiol Infect 2014; 20 (Suppl. 3): 76–98 (http://onlinelibrary.wiley.com/doi/10.1111/1469-0691.12360/pdf)
    4. Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association
of the Infectious Diseases Society of America. Guidelines for Prevention and Treatment of Opportunistic Infections in HIV-Infected Adults and Adolescents. 2015. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf
    5. Cornely OA et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: non-neutropenic adult patients. CMI, 18 (Suppl. 7), 19–37 (https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/ESCMID_Candida_Guidelines_CMI_Dec2012_non-neutropenic_adult_patients.pdf)
    6. Espinel-Ingroff A et al. Cryptococcus neoformans-Cryptococcus gattii species complex: an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for fluconazole, itraconazole, posaconazole, and voriconazole. Antimicrob Agents Chemother. 2012 Nov;56(11):5898-906. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3486550/pdf/zac5898.pdf)
    7. Espinel-Ingroff A et al. Cryptococcus neoformans-Cryptococcus gattii species complex: an international study of wild-type susceptibility endpoint distributions and epidemiological cutoff values for amphotericin B and flucytosine. Antimicrob Agents Chemother. 2012 Jun;56(6):3107-13. (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3370763/pdf/zac3107.pdf)
    8. Hope WW et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: prevention and management of invasive infections in neonates and children caused by Candida spp. CMI, 18 (Suppl. 7), 38–52 (https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/ESCMID_Candida_Guidelines_CMI_Dec2012_neonates_and_children.pdf)
    9. Ingibj÷rg Hilmarsdˇttir. Naemisprof – abendingar sveppalyfja Des 2015 Naemisprof - abendingar sveppalyfja Des. 2015.docxNaemisprof - abendingar sveppalyfja Des. 2015.docx
    10. Lortholary O et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: patients with HIV infection or AIDS. ESCMID Fungal Infection Study Group. Clin Microbiol Infect. 2012 Dec;18 Suppl 7:68-77.
    11. Pappas PG et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. CID 2016 (http://cid.oxfordjournals.org/content/early/2015/12/15/cid.civ933.full.pdf+html)
    12. Perfect JR et al. Clinical Practice Guidelines for the Management of Cryptococcal Disease: 2010 Update by the Infectious Diseases Society of America. Clinical Infectious Diseases 2010;50:291–322 . http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/Cryptococcal.pdf
    13. Schelenz S et al. British Society for Medical Mycology best practice recommendations for the diagnosis of serious fungal diseases. British Society for Medical Mycology. Lancet Infect Dis. 2015 Apr;15(4):461-74.
    14. Ullmann AJ et al. ESCMID* guideline for the diagnosis and management of Candida diseases 2012: adults with haematological malignancies and after haematopoietic stem cell transplantation (HCT). CMI, 18 (Suppl. 7), 53–67 (https://www.escmid.org/fileadmin/src/media/PDFs/4ESCMID_Library/2Medical_Guidelines/ESCMID_Guidelines/ESCMID_Candida_Guidelines_CMI_Dec2012_HCT.pdf)

    Ritstjˇrn

    Kristjßn Orri Helgason - krisorri
    Una ١ra ┴g˙stsdˇttir - unat
    Ingibj÷rg Hilmarsdˇttir
    Theˇdˇra GÝsladˇttir
    KatrÝn Helga Ëskarsdˇttir - katrinho

    Sam■ykkjendur

    ┴byrg­arma­ur

    Ingibj÷rg Hilmarsdˇttir

    ┌tgefandi

    KatrÝn Helga Ëskarsdˇttir - katrinho

    Upp »


    Skjal fyrst lesi­ ■ann 06/14/2010 hefur veri­ lesi­ 4544 sinnum

    © Origo 2019